Why aren’t depot antipsychotics prescribed more often and what can be done about it?

Maxine Patel is a Medical Research Council Special Training Fellow (Health Services Research) and an honorary specialist registrar at the South London and Maudsley NHS Trust (Maudsley Hospital, 103 Denmark Hill, London SE5 8AZ, UK. Tel: 020 7848 5136; fax: 020 7848 0572; e-mail: m.patel{at}iop.kcl.ac.uk). Her research interests include patient and staff attitudes to antipsychotics as well as insight and treatment adherence in psychoses. Tony David is Professor of Cognitive Neuropsychiatry at the Institute of Psychiatry and an honorary consultant at the South London and Maudsley NHS Trust. He has a long-standing interest in insight and schizophrenia. Both authors have received consultation fees from the pharmaceutical industry and have worked on two clinical drug trials for Janssen-Cilag.

Long-acting depot antipsychotics were developed specifically to promote treatment adherence (compliance) and they are a valuable option for patients requiring maintenance medication for schizophrenia. Depot use has fallen in recent years, perhaps owing to the introduction of oral atypical antipsychotics. Psychiatrist and patient acceptance of depot medication is variable. The depot formulation and the traditional ‘depot clinic’ seem to have an image problem, although many patients already receiving depot medication like it. Some psychiatrists may not adequately consider the risks and benefits when contemplating prescribing depot medication. Further, public opinion and planning forces in psychiatric health services may have a negative influence on the use of long-acting treatments. This review considers possible reasons for underutilisation of depot antipsychotics in maintenance treatment of schizophrenia and highlights the potential benefits and future role of depot drugs.

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Why indeed?: INVITED COMMENTARY ON... WHY AREN'T DEPOT ANTIPSYCHOTICS PRESCRIBED MORE OFTEN AND WHAT CAN BE DONE ABOUT IT?

Thomas R.E. Barnes
APT 2005 11: 211-213. [Full Text]  

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